What Are Warts?
Skin makes the first appearance of a person that makes him/her attractive and gives a glimpse of one’s lifestyle. A healthy, smooth and glowing skin is the dream of every individual especially females whose beauty is defined by their skin. Skin is the outermost layer and the largest organ of the body which covers all the other organs, bones, ligaments, muscles etc. and also acts as a protective shield. Having symptoms like redness, blisters, spots, cracks etc. on skin effects the overall beauty that could be nightmare to anyone. Despite of the fact that skin is the first layer of defense against various biotic and abiotic factors, it still gets affected by various factors such as chemicals or microbes that cause skin diseases.
Humans are associated with various skin diseases and depending upon the causal organism it could be bacterial, fungal, or viral. Wart is one of the very common viral skin diseases, and ranked at the third most common skin problem (1). Warts are generally the overgrowth of skin where cells are proliferated excessively and acquire various shapes and sizes on different parts of the body.
What Causes Warts? Where Do They Come From?
Warts are unusual skin growth forming a mass of skin cells that could be due to non-viral or viral infections (2). Non-viral warts are benign, non-contagious, epidermal tumors and popularly known as Seborrheic keratosis (3). However, viral warts are non-cancerous and contagious where viruses (human papillomaviruses or HPV) can enter through skin opening like cuts and triggers the cell proliferation . Non-viral warts mostly occur at the old age and commonly occur at neck, face and arms characterized by circular shape, sharp demarcation, and could be rough or smooth.
Sometime these warts become permanent in old aged people (4). Viral warts can emerge at any stage of life; in general, children and teenagers are the soft targets (5). The wart may be seen in different sizes from a pin size to a pea or even larger depending upon the time. It is a heap of skin layers looks like a cauliflower. It may also present in a single form to a series of formations. The contagious warts are visible after two to three months of infection and sometimes even more (6). Generally, wart is harmless but due to skin growth it might be itchy and painful, perhaps a black dot is also visible in the center which is clotted blood present in the capillaries and can come out or even bleed (7). Depending upon the wart there are various treatments are available, sometimes warts disappear on its own in few months time but might need proper care in few cases. Warts are more persistent in people with the weak immune system and must not be left untreated hence it may spread to another part of the body and also risks others.
What Are The Most Common Warts?
Viral and non-viral warts are categorized into various types on the basis of their appearance and area of infection.
Viral warts are of following types:
1. Common Warts:
It prevails in the skin around nails, fingers, and back of the hand. This is mostly rough in touch and varies in size and shape (8).
2. Plantar Warts:
Primarily localized in ankles and feet. In contrast to common warts, it grows inward due to body weight on feet and hence it’s painful (9). Viruses for plantar warts could be acquired from swimming pools, changing rooms etc.
3. Flat Warts:
They appear predominantly on a facial region like forehead and cheeks and could spread to hands. These are generally smaller in size.
4. Genital Warts:
This is a sexually transmitted viral infection, caused by HPV 6 and 11 in genital/anal areas called as condylomas. Genital warts bring itching or burning sensations and are highly vary in size and color, usually appear in clusters and are contagious.
5. Mosaic Warts:
These are often found on feet and either localized to a particular region or covers the entire feet. These are the pinhead-sized warts and hat doesn’t hurt.
6. Filiform Warts:
These generally appear on the face and named filiform on the basis of their shape which mostly threads like.
In contrast to viral warts which are visually distinguishable, various types of non-viral warts show histological differences and identified or characterized under a microscope, such as Acanthotic type, Hyperkeratotic type, Clonal type, Reticulated type, Irritated type, and pigmented type.
How Do You Get Rid Of Warts?
Most of the people are unaware of having a wart because of its harmless property. Warts mostly get healed by itself with time. Approximately 65 percent of the warts are resolved within two years. Especially in children and young adults, warts reappear itself more than once. Hence, multiple warts or reappearance of warts has to be treated to get permanent solutions (10).
Cryotherapy with liquid nitrogen is used very commonly for the treatment of common warts. It is the process where lesion (infected area) is frozen by liquid nitrogen. Freezing with extremely cold liquid kills the outer layer of skin cells forming a blister, which then removed easily. Cryotherapy is done repeatedly with the gap of at least one week to kill the wart from its root so that it won’t appear again. Because liquid nitrogen is too cold to bear, it often gets painful for some time, and also shows redness or swelling around the infected area (11).
2. Keratolytics Therapy:
Keratolytic agents such as salicylic acid and lactic acid are used for the treatment warts. Keratolytic therapy is painless but comparatively slow than cryotherapy. Though both the therapies can be combined, yet keratolytes cannot be used directly after cryotherapy because of its after effects. The procedure of keratolytic therapy is rather easy. The lesions are washed with soap and soaked in warm water for few minutes. Further rubbed with stone to remove dead skin cells and dried completely. Now, keratolytic is applied and allowed to dry completely.
Afterwards, a Band-Aid is a kept for 24 hours. This process repeated for 6 weeks or unless the wart is removed completely. It is always easy to remove single wart as compared to multiple warts through this method (12).
3. Cantharone Treatment:
Cantharon (Cantharidin or Verrusol) a vesicant agent that causes blistering, is used in the treatment of warts, usually for those patients who are unable to put up with the pain of cryotherapy. Only 0.7 percent is sufficient for the removal of warts. Apply Cantharidin to the lesion and leave it for drying. Afterwards, cover it with a tape for 24 hours. Later a blister starts appearing within 24-72 hours which might be painful. This process is repeated bi-weekly until it is cleared.
4. Impermeable Tapes:
Impermeable tapes also show effective results to get rid of warts. These tapes occlude the wart and start removing it layer by layer. Cover the wart with impermeable tape and left for the time till wart is completely moved out. Impermeable tapes such as duct tape, moleskin and Blenderm. These tapes are the foremost option for the children, but duct tape is less effective in adults (13).
Bleomycin sulfate, a chemotherapeutic agent, also shows high efficacy in the treatment of common warts. A mixture of 15 unit vial of bleomycin and 0.9 percent of sodium chloride, further with one percent lidocaine just at the time of medication is prepared. This solution is then injected beneath the wart, here the amount of solution injected depend on the size of the wart. Size less than 5mm needs 0.1-0.2 ml solution, between 5-10mm 0.2-0.4 ml solution is needed, and similarly greater than 10mm needs up to 1 ml. Multiple warts require up to 3 ml. This treatment may be repeated by every 2-3 weeks. Now, contradictory measures should be taken in the case of pregnancy, allergy of bleomycin, injecting the solution around the nails as they might get hurt and children due to their thin and sensitive skin (14).
Immunotherapy is a process in which the immune system of the patient is boosted up to fight for certain diseases. In the treatment of warts, immunotherapy is used in many different ways with a range of substances. Usually, it is used for warts which are difficult to treat permanently. Agents that are used in immunotherapy are Imiquimod, Mycobacterium w vaccine, Bacillus Calmette-Guérin vaccine, Measles, mumps, rubella vaccine, Candida antigen, Trichophyton skin antigen, Tuberculin, Interferons, Zinc, H2 receptor blockers, Levamisole, Human papillomavirus vaccines, Autoimplantation therapy etc. (15).
7. Surgical Treatment:
As the name suggests the wart is cleared with the help of surgery. This treatment includes two major therapy, Pulsed dye laser therapy and CO2 laser therapy. After the treatment, the wart turns gray-black in color which remains for few days. The process is repeated up to 3-4 weeks (16).
8. Natural Treatment:
Apart from all the chemical agents and surgery, there are a few natural remedies available for the treatment of wart. In a study on a pediatrics patient, tea tree oil showed positive results in just 12 days for warts present on hand (17). A case study shows that applying apple cider vinegar (ACV) can also give rid of wart, but the acidic properties of vinegar might hurt the area (18). But in few common warts ACV can be ineffective; however, another case study reveals the efficacy of Vitamin A on common warts. In this case, natural fish liver oil is used as it rich in Vitamin A, hence it is applied daily on the affected area and the positive results are observed in 70 days (19).
9. Photodynamic Therapy:
5-aminolevulinic acid (ALA) is most common prodrug which is administered externally to the warts. These agents accumulate porphyrin in cell, since porphyrin are photosensitizing so it absorbs the light of particular wavelength and induces the photooxidation cascades that damage the wart tissues. ALA is applied in the form cream or ointment over wart. This therapy is used for common warts, plantar warts and flat warts routinely. Sometime additional treatments are combined with this therapy to have better results for example, warts first treated with keratolysis using urea and salicylic acid and then ALA is applied to perform photodynamic therapy (20).
Are Genital Warts Curable?
Treatment of warts should be done by the doctors or medical practitioners to avoid any oversight. Maximum number of treatments is done by drying the surface of the warts, but in the case of few genital warts it is difficult to keep them dry, therefore podophyllin is used to treat moist surfaces. Other treatments like cryotherapy, imiquimod, green tea extracts containing sinecatechins, bichloroacetic or trichloroacetic acid (TCA), electrofulguration or electrocauterization, 5-FU 5 percent cream, Human Papillomavirus vaccination or intralesional IFN-a therapy can be used.
Genital warts can be observed in children too, with many other different causes. Vertical transmission, digital or auto inoculation, non sexual contacts or sexual abuse can become the means of transmission of HPV inside the body. Usually genetic warts in children are automatically clear the surface. If not, then also to treat them is comparatively easy as compare to adults. Treatments like light cryotherapy, podophyllotoxin or imiquimod can be applied for children. In case, when the wart has to be removed by surgery then a proper team of doctors with a pediatrician is required, and the child is treated with anesthesia before the surgery (21).
How Do You Prevent Warts?
There are more than 100 different types of HPV present which are responsible for warts. Warts can occur on any part of the body. Nongenital warts mostly present on feet, hands, face etc, whereas genital warts present inside and around the genital area. Warts are contagious, and hence can be easily acquired by walking barefoot with many people, or using a common shower. Butchers and meat handlers often have warts on their hands. A person with immunosuppression is also at high risk (22). Other factors are skin injuries or any cut may give a way for HPV to enter. Having contact with other person’s wart or scratching on warts of own body also spread warts to other body parts. Body parts such as hands and feet if sweats a lot induce the chances of being infected (23). Genital warts are commonly spread through sexual transmission (24).
The best way to inhibit warts is to focus on the risk factors. Not to use common showers, not to touch anyone’s wart, not to share towels, shoes, socks etc. are common precautions. Covering the wart with some tape, keeping the skin dry, and avoid scratching will restrict its spread to other body parts (25).
Every disease brings myths and misconceptions with it, similarly there are various myths associated with warts too such as toads or frogs causes wart, warts cannot be removed etc. Myths must be kept at bay to avoid any accidents or mistreatment. One such example also includes treating wart with nail polish, this is considered to be a home remedy however no scientific explanation is available for the effectiveness of nail polish to treat warts.
A proper precaution will let you free from any skin anomaly and an appropriate treatment will not only heal the issue but also protects others.